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ACCS Pharmacology
These are all drugs that are on the ACCS testing matrix. If you're current with your ACLS pharmacology you're ahead of the game. Cardiac Medications Nitroglycerine (NTG) - reduces PVR, blood pressure, relaxes smooth muscle Propanolol - Beta-1 blocker, used for sustained tachycardia Lidocaine - Vasodilator. Reduces heart rate, treats PVCs Digitalis - treats CHF, right sided heart failure. Increases CVP and K+ Labetalol - Beta-1 blocker, Reduces blood pressure, heart rate Epinephrine - Increases HR, main use is during CPR Atropine - Treats bradycardia and myasthenia gravis crisis due to its anticholinergic effect Adenosine - Treats supraventricular tachycardia (doses are 6,12,6mg) Pulmonary Vasodilators Nitric Oxide (NO) - potent pulmonary vasodilator. Use in adults is strictly for pulmonary hypertension. Start at 20-40 ppm Sildenafil (Viagra) - NOT USED IN THE ICU SETTING - Reduces pulmonary arterial pressure and pulmonary vascular resistance Flolan (estoproterenol) - Can be given via IV or aerosol - Indicated for ARDS, surgery related PHTN. Also called prostacyclin or PG12. Watch for drops in CVP, anuria, and reduced blood pressure Sedatives/Hypnotics Dexmedetodine (Precedex) - Short acting novel sedative. Watch for BP changes and atrial fibrillation. Propofol (Diprivan) - Used for RSI due to short half life and good for sedation vacations. Watch for hypotension (switch to Etomidate in case this happens) Nembutal (Pentabarbatal) - Use when intracranial pressure is above 26. Paralytics Depolarizing: Succinylcholine Chloride (Anectine) - Depolarizing agent. Lasts around 10 minutes. Good for RSI. Caveats: Raises K+. Do NOT use in burn cases, brain injury, or airways with a Mallampati Score of 3 or above. Non-Depolarizing: Rocuronium, Vecuronium, Pancuronium - Use on hyperkalemic patients, burns, increased ICPs. Reversed with: Sugmmadex (Bridon) - do not use this in renal patients! Can also cause bradycardia. Pyridostigmine Reversal Agents Narcan - Reverses opioids. Side effects include hypertension and tachycardia. Use in overdose cases - keywords you want are "Morphine PCA", "Fentanyl", "Overdose w/pin-point pupils" Flumazenil (Romazicon) - Reverses benzodiazepines. Side effects include respiratory depression, hypotension, and somnolence. Key phrase you are looking for are "Patient s/p surgery on benzo drip" - Caveat - Do not intubate unless patient is in respiratory distress! Vasodilators Dobutamine - Increases cardiac output and heart rate. Is a systemic vasodilator. Use in patients with left ventricular dysfunction. Flolan - Reduces pulmonary arterial pressure. Vasopressors Dopamine - Increases heart rate and blood pressure Norepinephrine (Levophed) - Increases blood pressure. Use when/if dopamine fails to maintain MAP. Use when IV fluid intake increases yet patient still hypotensive. Vasopressin - Used with epinephrine during CPR. Increases blood pressure. Can stop bleeding during bronchoscopy. Antibiotics Penicillins - treat Gram positive organisms. Use oxacillin or nafacillin if bacteria are resistant. Use Keflex, Keflin, Erythromycin, or cephalosporins of patient has a penicillin allergy. Bactrim - Treats UTI, PJP pneumonia, is not a first line treatment for upper respiratory infection, however. Levaquin - Treats a wide range of pulmonary and systemic infections. Look for increased white cell count, fever, opacities on CXR. Mycins - Tobramycin, Gentamycin, Vancomycin - Use if patient is infected with gram NEGATIVE organisms. Cefepime (Maxcef) - use in sepsis w/increase in white cell count Benzodiazepines Anticoagulants Pain Control Diuretics Miscellaneous Category:Pharmacology Category:ACCS Category:ACLS Category:Adult Critical Care